Smokers in long-term care a health/safety issue

Soon after the state's new smoking ban passed, Lake Vue Gardens nursing home in Kirkland told residents who smoke that they'd have to start puffing off the premises.

Their old smoking spot — a covered gazebo in the courtyard — was now officially too close to the windows of nonsmokers, many of whom suffered from respiratory problems.

"I've smoked for — oh, lord — about 65 years," said resident Jane Goergen, 80, who has lost both legs to poor circulation. "It never occurred to me that when I got old and trapped in a nursing home I wouldn't be able to smoke."

For safety's sake, the Lake Vue smokers were outfitted with reflective orange jackets and flashlights. Poles with flags were installed on their wheelchairs, along with reflective stickers.

But the off-site solution lasted just a few days, until one smoker ran into a pothole and fell out of her wheelchair.

The situation at Lake Vue highlights the challenges that are emerging as long-term-care facilities across the state try to comply with the new smoking law while also satisfying other existing laws meant to protect the rights of residents — smokers and nonsmokers alike.

The law bans smoking inside any public place or workplace and within 25 feet of doorways or windows that open.

What distinguishes long-term-care settings — nursing homes, adult family homes and assisted-living facilities — from bars, theaters, department stores and office buildings is that they are also homes to about 60,000 people.

After the initiative went into effect in December, long-term-care providers responded in a variety of ways:

• Many of those unable to comply with the 25-foot rule decided to stop admitting smokers.

• Others are allowing smoking to continue because they have enough outdoor space to comply with the 25-foot rule.

• Still others are applying for waivers and may build new outside smoking shelters.

"It's truly a balancing act between the residents who smoke and the residents who don't," said Nancy Butner, administrator at Lake Vue, which has a very narrow strip of ground surrounding its building in a residential neighborhood.

"Right now the only 25 feet I have is to the front of the building. But that doesn't make sense because of traffic."

After the pothole accident, the smokers started to congregate in a nearby corner of the parking lot, but then a van nearly backed into a 35-year-old resident who also was in a wheelchair. Christine Kasprzyk was unhurt after her close call.

"I thought, oh, my God, this is ridiculous," said her mother, Carole Kasprzyk. "To be put in harm's way just to have a cigarette."

Lifelong habit for some

The situation is potentially serious enough that the state's long-term-care ombudsman tried to get nursing homes exempted from the ban's 25-foot provision.

Kary Hyre got a bill introduced in the recently concluded legislative session that also would have allowed homes to set up ventilated smoking rooms. He argued that I-901 essentially bans all smoking in long-term-care facilities, whereas previously residents could step outside to smoke or do so in specially designated indoor areas.

"I'm most concerned about people who have a lifelong habit," said Hyre. "You can put patches on, but that doesn't stop them from wanting to smoke. It just drives it underground, and then it's unsafe for everybody."

Meanwhile, even long-term-care facilities that have stopped admitting smokers are supposed to make reasonable accommodations for their current smokers, state officials say.

And that may include having staff members to supervise smokers who can't smoke on their own.

"You can't kick them out because they smoke," said Linda Ronco, the state's nursing-home compliance specialist in the Department of Social and Health Services.

While the state long-term-care inspectors are responsible for monitoring quality of care and protecting residents' rights, they aren't responsible for enforcing the new smoking law. That's up to local health districts.

It may be too early to tell exactly how the ban will play out in long-term care. So far, Ronco has not heard of serious problems in its implementation.

"We've been waiting and we expect it, but we haven't heard it," she said.

Hyre, the state ombudsman who advocates for long-term-care residents, theorizes that some smokers who are asked to leave won't resist. Others will complain, and his staff will "go argue with the facility about what their responsibility is."

But Hyre isn't sure if state inspectors would uphold his office's recommendations.

If a resident insists on smoking and someone else complains about it, public-health officials can cite a facility for not obeying the ban, he said.

In King County, health officials so far haven't received complaints about violations in long-term care. But they say they don't consider the 25-foot distance a hard and fast rule, and they're trying to be flexible with affected establishments.

"There's still a lot of confusion about what that 25-foot distance meant," said Roger Valdez, tobacco-prevention program manager at Public Health — Seattle & King County.

Basically, "they need to be smoking in a way where smoke is not drifting inside the building."

No smoking allowed

At least one nursing home in Seattle, Bailey-Boushay House in Madison Valley, has decided to become a nonsmoking facility because it doesn't have space to meet the 25-foot provision.

Residents who smoke have been told they must stop, smoke off the property or move.

The facility will help anyone who decides to move find other housing, and is providing nicotine patches and counseling for smokers trying to quit.

There hasn't been a lot of pushback from smokers about the change, according to spokeswoman Kim Davis.

For similar space reasons, Extendicare, a nationwide long-term-care corporation, has also decided to go smoke-free at 10 of its 15 nursing homes in Washington. Management also decided it won't ask staffers to assist residents who can't smoke on their own.

In those smoke-free homes, current residents who smoke will have to quit, smoke off the property or leave. The company will offer people smoking-cessation tools or help to relocate, if necessary.

If a facility is cited for violating the rights of residents to smoke, the corporation will take the matter to dispute resolution.

"We have really tried hard to do what's right; that's our primary objective," said Carl Tabor, Extendicare's Northwest area director of clinical services.

Sean Bradbrook, 36, broke his neck in a diving accident and can't light his own cigarettes. He lives in an Extendicare nursing home in Vancouver, Wash., and has been instructed to find a volunteer who will help him smoke across the street.

"I really don't have anybody to come with me," said Bradbrook. "I immediately tried to find another place to live. But it looks like I'm not going to have another place to move where I can smoke."

In contrast, the state Department of Veterans Affairs continues to allow smoking on the campuses of its three nursing homes in Washington. Staff members are asked to volunteer to help smokers who need assistance, and those volunteers are usually smokers themselves.

Two of the homes are seeking waivers from the 25-foot rule until they can build new smoking shelters at that distance.

"Most of our residents are from the World War II and Vietnam eras, when they were still issued cigarettes in C-rations," said Jon Clontz, superintendent of the Washington Veterans Home, which has a 35-acre campus at Retsil on the Kitsap Peninsula.

"Most of these men began smoking in combat. They've had that habit for many years."

In response to the recent mishaps at Lake Vue, smokers there are now allowed to light up at the far end of a covered and lighted front porch, behind a row of potted evergreens where delivery trucks unload.

The location, while unheated, offers more shelter, but technically it's not as far from doors and windows as it's supposed to be.

Lake Vue also has stopped admitting smokers and encouraged those who do smoke to stop, offering counseling, nicotine patches and gum. About half a dozen have taken the offer and succeeded.

For now, most of Lake Vue's smokers bundle up and wheel out to the front porch several times a day. The porch is better than the street or parking lot, they say, though not as good as the gazebo.

For resident Jane Goergen, the new restrictions have brought her back to where she started out smoking so long ago. As soon as she turned 18, Goergen announced that she had the right to smoke.

Her dismayed mother tried to set limits and forbade her to smoke inside the house: "Jane, you're going to sit out on the front porch, rain or shine."

Marsha King: 206-464-2232 or mking@seattletimes.com